Provider Demographics
NPI:1114564408
Name:ANAGNOS, GRACE (MA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ANAGNOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 53RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2234
Mailing Address - Country:US
Mailing Address - Phone:314-852-6022
Mailing Address - Fax:314-852-6022
Practice Address - Street 1:4011 53RD AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2234
Practice Address - Country:US
Practice Address - Phone:314-852-6022
Practice Address - Fax:314-852-6022
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health